布加综合征合并下腔静脉陈旧性血栓的腔内治疗

Treatment of Budd-Chiari syndrome with chronic inferior vena cava thrombosis

目的评价下腔静脉（IVC）型布加综合征（BCS）合并IVC陈旧性血栓形成的治疗方法、疗效及预后。方法回顾性分析2004年4月至2014年4月因膜性或短段闭塞性IVC型BCS合并IVC陈旧性血栓形成于本院行介入治疗的119例患者的临床资料,比较行小球囊预开通治疗及可回收支架治疗患者的疗效差异。结果 119例患者中,56例接受小球囊预开通治疗（预开通组）,63例接受可回收支架治疗（可回收支架组）。除可回收支架组有1例患者术中发生支架断裂、经外科手术外,其余118例患者介入手术均成功。术后两组患者均取得满意疗效,预开通组与可回收支架组两组间尿激酶用量、溶栓时间、住院时间及并发症发生率比较,差异均无统计学意义（P〉0.001）,预开通组花费更低（P〈0.001）。术后119例患者均获随访,随访时间为18~66个月,平均44.2个月。随访期间,预开通组及可回收支架组分别有6例患者发生原闭塞处的再次狭窄闭塞,预开通组与可回收支架组复发率无明显差异（P=0.23）。复发患者经再次扩张治疗后未再发生管腔狭窄和血栓形成。结论小球囊预开通技术及可回收支架技术治疗IVC型BCS合并IVC内陈旧性血栓的效果满意,且前者更经济安全。

Objective To investigate the therapeutic method,curative effect and prognosis of inferior vena cava（IVC） blocking Budd-Chiari syndrome（BCS） with chronic inferior vena cava thrombosis. Methods Clinical data of 119 cases of membranous or short-segment occlusion BCS with IVC thrombosis,who accepted interventional treatment in our hospital,.were analyzed retrospectively..The differences of curative effect in predilation group and stent filter group were compared. Results Thereinto,.56 cases were predilated by small balloon（predilation group）, for the rest 63 patients, a stent filter was deployed（stent filter group）. Besides 1stent filter fractured during the first removal attempt and had to be extracted surgically in the stent filter group, the other patients were technically successful without procedure-related complication. Curative effect was satisfactory in all patients, and there were no statistically significant differences between predilation group and stent filter group in dosage of urokinase, urokinase thrombolysis time, hospital stays and incidence of complication（P〉0.001）. The cost of predilation group was lower（P〈0.001）. All 119 patients were followed up for 18~66 months（mean, 44.2 months）. During the follow-up period,.reobstruction of the IVC was observed in 12 patients without thrombosis,.of which 6 cases in the predilation group,.and the rest 6 cases in the stent filter group. There was no significant difference in recurrence rate between predilation group and stent filter group（P=0.23）. Patients with recurrence got re-expansion treatment,.and no stenosis or thrombogenesis recurred.Conclusions Predilation and stent filter techniques are all effective in the treatment of BCS with chronic IVC thrombosis,.but the former seems to be safer and more economic.